Forecasting waiting lists for elective procedures and surgery in England: a modelling study

IntroductionThe aim of this study was to forecast the total need for elective procedures in England by 2030. MethodsWe used publicly available activity data from NHS Digital to estimate procedure- level shortfalls in elective procedures performed during the pandemic period (January 2020 to March 2022) compared to what would be expected based on pre-pandemic trends. We also estimated the procedure-level composition of the NHS waiting list immediately preceding the pandemic (December 2019). The total need for elective procedures in March 2022 was calculated by summing the pandemic shortfall with the pre-pandemic NHS waiting list. We projected the need for elective procedures through to January 2030 for four scenarios: current capacity (surgical volume remains at the same level as in February-March 2022), pessimistic scenario (elective procedure volume increases to pre-pandemic levels by July 2023 followed and remains at this level until 2030), central scenario (elective procedure volume returns to pre-pandemic levels by December 2022 followed by a 2% increase per year), optimistic scenario (elective procedure volume returns to pre-pandemic levels by December 2022 followed by a 4% increase per year) ResultsWe estimated the total need for elective procedures in England in March 2022 was 4,347,469. Of these 4,347,469 patients, 3,304,513 (76.0%) were on a hidden waiting list. The greatest need was for General Surgery (1,522,366), Orthopaedics (976,875), and Ophthalmology (391,683). The procedures with the greatest need were sigmoidoscopy and colonoscopy (568,838), gastroscopy (447,830), cataract surgery (314,790), lower limb joint replacement (224,363), and interventional cardiology (349,300). We projected that at current capacity, the total number of elective procedures needed would increase to 14,608,195 by 2030. In the pessimistic scenario, elective procedure volume total elective procedures needed would increase to 8,507,087, in the central scenario it would increase to 5,420,999, and in the optimistic scenario it would decrease to 2,584,664 procedures. DiscussionThe estimate of 4.3 million elective procedures needed in England is considerably higher than the official NHS waiting list, reflecting a large hidden waiting list. Even in the most optimistic scenarios there will be a substantially larger waiting list in 2030 than pre-pandemic.